Latest / AHF Podcast / Rewriting Patient Recovery (Interview with Andrew Wickline, MD)

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Rewriting Patient Recovery (Interview with Andrew Wickline, MD) · AHF Podcast

• 0:24
  Joseph M Schwab: Hello, and welcome to the AHF Podcast.
• 0:26
  Joseph M Schwab: I'm your host, Joe Schwab.
• 0:29
  Joseph M Schwab: Dr.
• 0:29
  Joseph M Schwab: Andrew Wickline is an orthopedic surgeon, educator, and author of two books, less Swelling, less Pain, total Hip.
• 0:37
  Joseph M Schwab: And less swelling, less pain, total knee.
• 0:39
  Joseph M Schwab: Both books are now available in Spanish reflecting his deep commitment to accessible patient care and education.
• 0:47
  Joseph M Schwab: Dr.
• 0:47
  Joseph M Schwab: Wickline, thank you for joining us.
• 0:51
  Andrew Wickline: Good morning from upstate New York.
• 0:52
  Andrew Wickline: Glad to be here.
• 0:54
  Joseph M Schwab: Um, let's start with your book.
• 0:56
  Joseph M Schwab: Uh, less pain, less, uh, excuse me, less Swelling, less Pain.
• 0:59
  Joseph M Schwab: What inspired you to write these and what's really your goal in making them available to a wider audience, including Spanish speaking patients?
• 1:07
  Joseph M Schwab: I.
• 1:09
  Andrew Wickline: Well, uh, back in 2015, I heard, uh.
• 1:12
  Andrew Wickline: Dr.
• 1:12
  Andrew Wickline: Craig McAllister and Dr.
• 1:13
  Andrew Wickline: Ira Kirschenbaum, they, they talked about how, um, patient engagement was the key towards allowing patients to go home the same day.
• 1:22
  Andrew Wickline: And, uh, so they convinced me to kind of write my, my version of the book and took me six months.
• 1:28
  Andrew Wickline: I mean, most surgeons were busy.
• 1:29
  Andrew Wickline: They've got a bunch of flyers they hand out at at different time points postoperatively.
• 1:34
  Andrew Wickline: But I sat down, I said, what if I was a patient?
• 1:36
  Andrew Wickline: What.
• 1:36
  Andrew Wickline: What would that book look like?
• 1:37
  Andrew Wickline: You know, when your daughter, uh, or wife gets pregnant for the first time, she gets this book called What to Expect When You're Expecting.
• 1:43
  Andrew Wickline: Right.
• 1:44
  Andrew Wickline: Everybody in the United States has seen that.
• 1:46
  Andrew Wickline: Um, and then, you know, if you have a family member, uh, like with my wife, when she had cancer, we had this amazing book to Breast Cancer handbook, you know, how to, how to Succeed and get through this really terrible time.
• 1:56
  Andrew Wickline: And I recognized that Total Knee and Total Hip, it's not a lot of fun and it's a, it's a big black box for patients so.
• 2:03
  Andrew Wickline: I, I wrote the, the first book, I've, I've revised it 31 times and since that time of the very first book, we've published lowest opioid use in the United States.
• 2:12
  Andrew Wickline: We, uh, just published lowest swelling worldwide after knee replacement.
• 2:16
  Andrew Wickline: And so I thought it was time to, to bring the, uh, that, that data, those publications all in one book to patients, uh, direct to patients.
• 2:25
  Joseph M Schwab: So what have you seen or, or in your research, what is the landscape for current, you know, patient recovery education look like?
• 2:35
  Andrew Wickline: So it's kinda all over, uh, the, the, uh, field.
• 2:38
  Andrew Wickline: It's, you know, I, I've, I've operated with many, many different surgeons, uh, over 60 surgeons.
• 2:44
  Andrew Wickline: Uh, and, uh, and it's, you know, when you're busy, when you're not busy, you, you have time to do all these things, but once you get busy, it's really challenging the way, um, uh, most surgeons do it.
• 2:57
  Andrew Wickline: They've got their handouts again, just like what I was doing, but it, it's.
• 3:02
  Andrew Wickline: It's very hit or miss and it's very sporadic.
• 3:04
  Andrew Wickline: I really think we could do a better job at tightening up the protocol.
• 3:08
  Andrew Wickline: Um, you know, otherwise patients go to Dr.
• 3:11
  Andrew Wickline: Google and that's, that's a terrifying experience.
• 3:13
  Andrew Wickline: You know, I, I've got 8,200 hours of my life, you know, that's four full-time years of working, uh, nights and weekends away from my, my wife and kids, you know, and I, and I tell patients, listen, this is my love letter to you.
• 3:25
  Andrew Wickline: I took time away from my family to help you succeed.
• 3:28
  Andrew Wickline: And so.
• 3:29
  Andrew Wickline: They would take the book, they would journal in it.
• 3:31
  Andrew Wickline: I've got 7,000 patients that have given me the book back, and I, I, I'm able to see really amazing detailed descriptions about what happens every day post-op, what to expect.
• 3:42
  Andrew Wickline: It's not just black and white, a pain score, a three or a four.
• 3:45
  Andrew Wickline: It's, you know, actual sentences.
• 3:47
  Andrew Wickline: Hey Doc, I really have trouble rolling over at night.
• 3:49
  Andrew Wickline: You know, what, what, what is that?
• 3:50
  Andrew Wickline: Normal?
• 3:51
  Andrew Wickline: And, and patients are worried.
• 3:52
  Andrew Wickline: They wanna know what's normal, what's not.
• 3:54
  Andrew Wickline: And it answers every question the last 23 years of practice.
• 3:57
  Andrew Wickline: You know, can I have a flu shot?
• 3:59
  Andrew Wickline: Uh, what are the parts made of, uh, what's the best diet?
• 4:02
  Andrew Wickline: Uh, am I ready for surgery?
• 4:03
  Andrew Wickline: I got two whole pages to help patients determine, am I ready for surgery?
• 4:08
  Joseph M Schwab: Is it, so you mentioned Dr.
• 4:10
  Joseph M Schwab: Google.
• 4:11
  Joseph M Schwab: Is that how you find most patients are currently learning about recovery?
• 4:14
  Joseph M Schwab: Apart from, of course, the.
• 4:15
  Joseph M Schwab: The patients that you're given your book to.
• 4:18
  Andrew Wickline: It seems like it, you know, uh, when you look online, look at the blogs, there's lots of, you know, um, uh, patient organized blogs to, uh, to kind of help people because, because their doctor isn't doing it, you know, isn't providing the information, and so they feel the need to do it themselves.
• 4:33
  Andrew Wickline: So I.
• 4:34
  Andrew Wickline: Um, this is one way that, that you can have qualified information if you, if patients look in my book, I, I've got, uh, references to each of the articles that are published that help, uh, show them where they can find, actually find the science behind the recommendation I'm giving them.
• 4:50
  Joseph M Schwab: Yeah.
• 4:50
  Joseph M Schwab: And do you find, does your book also sort of create or recreate that sense of maybe community that some folks feel online with an online blog?
• 5:01
  Andrew Wickline: I think so because there's actual patient quotes every single day post-op.
• 5:06
  Andrew Wickline: So the book is kind of divided in two, two parts, you know?
• 5:08
  Andrew Wickline: Um.
• 5:10
  Andrew Wickline: What to expect before surgery.
• 5:11
  Andrew Wickline: How to optimize each of the different body systems, you know, if you're a man, if you have prostate issues, did you know that, you know, certain types of anesthesia can put you at more risk for having, uh, you know, prostate, you know, problems post-op and wearing a catheter.
• 5:24
  Andrew Wickline: Nobody wants that and nobody's gonna be happy with that, with that outcome.
• 5:28
  Andrew Wickline: So at least if you can discuss it with patients, that helps, you know, post-op, uh, uh, you know, I generally have a, a, a good comment and a and a.
• 5:36
  Andrew Wickline: And a patient who's got having a rough day comment to kinda show that range, uh, so that, um, patients can say to themselves, well, I guess this is normal.
• 5:44
  Andrew Wickline: I, you know, I thought I was worried when I woke up this morning with this new problem.
• 5:48
  Andrew Wickline: Uh, and um, but geez, there's four quotes in the book that said this is normal.
• 5:54
  Joseph M Schwab: Of course, patients have access.
• 5:56
  Joseph M Schwab: All, All patients everywhere would have access to your book, right?
• 5:59
  Joseph M Schwab: It's available, you know, for them to purchase.
• 6:01
  Joseph M Schwab: But for a, a number of patients who are seeing their doctor are getting their, uh, information directly from their doctor.
• 6:09
  Joseph M Schwab: Um, what concerns you most about kind of the current approach that surgeons are taking towards educating their patients about their recovery?
• 6:20
  Andrew Wickline: Well, you know what's been really helpful is I've had several surgeons, hips and, you know, surgeons who've had hips and knees who've actually got, purchased my books and, uh, reached out to me and said, wow, I did not realize this or that, or this or that.
• 6:35
  Andrew Wickline: And that's the surgeon themselves, right?
• 6:37
  Andrew Wickline: Who's, who's been doing this for 5,000, 10,000, 20,000 cases.
• 6:41
  Andrew Wickline: And, um, it's, it's really hard to put yourself in those shoes until you've.
• 6:46
  Andrew Wickline: Until you've walked it.
• 6:47
  Andrew Wickline: Right.
• 6:47
  Andrew Wickline: I, I've had patients stay at my house, uh, because of covid and a few, uh, challenging, uh, situations.
• 6:54
  Andrew Wickline: And, um, you really start to learn a lot more about what recovery's like when you actually go and visit the therapist and watch the patients, uh, being tortured after surgery.
• 7:04
  Andrew Wickline: Uh, because our industry has told patients to go, go, go.
• 7:08
  Andrew Wickline: And, uh, and I think that's a mistake.
• 7:10
  Andrew Wickline: We, we certainly don't do that.
• 7:12
  Andrew Wickline: If you sprain your ankle, you wouldn't.
• 7:14
  Andrew Wickline: Walk, you know, 10,000 steps the night after Spraining your ankle.
• 7:17
  Andrew Wickline: We've all learned that lesson as a teenager.
• 7:19
  Andrew Wickline: So I think part of it is just we, we really, um, we all go to these meetings.
• 7:24
  Andrew Wickline: We focus on the one hour of surgery at the meetings, but, but there's six weeks pre-op, 12 weeks post-op, that's 3000, 24 hours that we could be focusing on, and yet we only focus on one.
• 7:35
  Joseph M Schwab: Yeah, and it's interesting'cause a lot of the publications about outcomes for total hip, total knee, you know, they'll want two year outcomes and a lot happens in that first two years.
• 7:44
  Joseph M Schwab: What's the incentive for the surgeon to focus on that recovery in the first three months if really, you know, most of the literature is on two year outcomes.
• 7:56
  Andrew Wickline: So you are right, and it's just easy to tell patients.
• 7:59
  Andrew Wickline: Well, it'll all be better in, you know, uh, at a year or two years and, you know, hang in there.
• 8:04
  Andrew Wickline: But I.
• 8:04
  Andrew Wickline: But again, if you have something that's actually documented, that's published that, that has data behind it, that, that with publications, at least the patient, if that's the, the case, which again, there is healing out to two years, nine, it takes 92 years to get 98% healing of the wound.
• 8:20
  Andrew Wickline: Um, you know, at least the patient can see it.
• 8:22
  Andrew Wickline: And, and it.
• 8:23
  Andrew Wickline: It, it feels more like it's the truth, right?
• 8:26
  Andrew Wickline: When we tell, if a patient says, doc, I'm still sore at three months, and the doc says, well, that's normal, and, and it'll all get better by a year.
• 8:34
  Andrew Wickline: It kind of feels like we're brushing them off.
• 8:36
  Andrew Wickline: But yeah, they can see in the book that it says, you know, here's.
• 8:39
  Andrew Wickline: You know, you only have 50% healing at week six.
• 8:42
  Andrew Wickline: You know, at three months you're gonna have 15% more water in your leg than normal still.
• 8:46
  Andrew Wickline: Um, okay, well that is, that's a reason why I'm still sore and it's okay.
• 8:51
  Andrew Wickline: This, it, it's not an infection.
• 8:52
  Andrew Wickline: I'm not rejecting the implant.
• 8:54
  Andrew Wickline: People think they reject implants, so, you know, again, the mind goes to the darkest place.
• 8:59
  Andrew Wickline: Um, that's, that's what happens when we encounter something that, that no one gave us an explanation for before.
• 9:06
  Joseph M Schwab: Is there anything we should be doing in the literature to change the incentive structure for patients?
• 9:13
  Joseph M Schwab: Or excuse me, for, for surgeons to be making, uh, patient recovery education a higher priority?
• 9:22
  Andrew Wickline: Um, well, I can say that, that, so to incentivize, I don't think the literature is going to push unless, unless you can, you know, I.
• 9:30
  Andrew Wickline: Do this large multicenter study with a specific protocol and follow these patients for two years.
• 9:37
  Andrew Wickline: I mean, I guess that's one way to do it in the literature, but.
• 9:40
  Andrew Wickline: Boy, that's gonna be a challenge to get done.
• 9:43
  Andrew Wickline: And who's gonna pay for that?
• 9:45
  Andrew Wickline: You know, uh, I think really what needs to happen is, uh, the, the government needs to incentivize surgeons to do this, right?
• 9:52
  Andrew Wickline: Um, you know, we've published lowest opioid, lowest swelling, uh, uh, and with that comes, uh, you know, over a 50% reduction in 90 day recidivism rate, you know, coming back to the hospital.
• 10:04
  Andrew Wickline: So lower complications using this protocol.
• 10:07
  Andrew Wickline: And so.
• 10:08
  Andrew Wickline: You know, I think if we can incentivize, if the government says, you know, let's incentivize surgeons to, to reduce opioid prescribing and reduce complications, that's the way to do it.
• 10:17
  Andrew Wickline: I, I, I, I guarantee if the government came out tomorrow and said, we're gonna pay surgeons an extra thousand dollars, uh, for lower opioids, lower complications, and, and there's no, um.
• 10:29
  Andrew Wickline: Uh, and there's no downside to it.
• 10:31
  Andrew Wickline: Like they did that for B-P-C-I-A, right?
• 10:33
  Andrew Wickline: The, the, the government plan.
• 10:35
  Andrew Wickline: But, but boy, that was Russian roulette.
• 10:36
  Andrew Wickline: Like many people got burned because, you know, got a readmission, um, because they didn't have the right protocol.
• 10:43
  Andrew Wickline: How about we just incentivize people to, to uh, do the right thing And, uh, and, and if, if you win, you get to share in the savings.
• 10:51
  Andrew Wickline: And if not, you're trying hard to win.
• 10:53
  Andrew Wickline: I think we just need to refocus on this.
• 10:56
  Joseph M Schwab: So, shifting gears a little bit, one thing that really stands out about your career, um, uh, just looking over it, is your dedication to learning from others.
• 11:06
  Joseph M Schwab: And you've, um, I I read that you've either visited or hosted over 60 surgeons over the last 20 years, which is a truly remarkable number.
• 11:15
  Joseph M Schwab: Uh, and I'm curious to know from your perspective, what inspired this, uh, interest in an exchange of ideas.
• 11:24
  Andrew Wickline: Well, I think it's a couple things.
• 11:25
  Andrew Wickline: Um.
• 11:27
  Andrew Wickline: First, you know, as a resident, we don't, we don't learn by just going to a, you know, a, a two hour lecture or, or a two two day weekend le series of lectures.
• 11:36
  Andrew Wickline: We, we operate with multiple different surgeons and we we're, we're watching different artisans and learning from their craft, right?
• 11:43
  Andrew Wickline: And so that's how to do the procedure.
• 11:45
  Andrew Wickline: But then, you know, um.
• 11:48
  Andrew Wickline: The real key is going to the office and actually seeing those patient outcomes more than a, a binary, you know, a, you know, zero one or a, or a pain score or a, um, a prom score that, that's not as really helpful as actually seeing the patients that, that are in each of these surgeon's office.
• 12:06
  Andrew Wickline: So I think, I think that's.
• 12:08
  Andrew Wickline: I mean, that's how we learn and, you know, as residents.
• 12:10
  Andrew Wickline: So why aren't we doing that when we, when we leave fellowship?
• 12:13
  Andrew Wickline: And the number two reason is I'm from West Virginia.
• 12:16
  Andrew Wickline: Uh, I didn't have a lot of money growing up.
• 12:18
  Andrew Wickline: I was always told I was second best.
• 12:20
  Andrew Wickline: And, um, you know, some people they knuckle under that pressure.
• 12:23
  Andrew Wickline: They, you know, I was told I wasn't ever gonna be able to be a surgeon.
• 12:26
  Andrew Wickline: Um, let, let alone, um, you know, uh, successful.
• 12:31
  Andrew Wickline: And so some people will knuckle under and I, I just made me mad so.
• 12:34
  Andrew Wickline: I, um, I said, no, I'm gonna prove to people.
• 12:37
  Andrew Wickline: So that was very helpful in some ways, but it's, it's a monkey on your back, right?
• 12:42
  Andrew Wickline: I, and, and so I.
• 12:44
  Andrew Wickline: At Aus, unfortunately, that we see this still.
• 12:47
  Andrew Wickline: I, I stood up in 2013 and I said, you know, I think we're hurting patients with therapy.
• 12:53
  Andrew Wickline: I live in a small town.
• 12:54
  Andrew Wickline: I'm seeing patients really suffering.
• 12:55
  Andrew Wickline: I think we should stop therapy.
• 12:57
  Andrew Wickline: And the whole, the whole room laughed and you know, you know, because when I said we should stop there, and I, I persisted.
• 13:04
  Andrew Wickline: I said, no, I, I'm in a small town.
• 13:05
  Andrew Wickline: I'm, I'm, I was one of the busiest striker users in New England at the time.
• 13:09
  Andrew Wickline: And, uh, I, I do a lot of work and, and a guy in the lectern actually said, no, we're serious.
• 13:14
  Andrew Wickline: Shut up.
• 13:15
  Andrew Wickline: Sit down if you believe that nonsense.
• 13:17
  Andrew Wickline: Come back when you have something published.
• 13:20
  Andrew Wickline: And that was mortifying to me.
• 13:22
  Andrew Wickline: And you know, again, kinda my whole life, I've been told I'm second best now here I am with all my computers.
• 13:26
  Andrew Wickline: You're second best.
• 13:27
  Andrew Wickline: So, so I, I, in hindsight, I want to thank that gentleman, uh, because he spurred me to start looking at my outcomes and start looking at more than just the surgery.
• 13:37
  Andrew Wickline: I.
• 13:37
  Andrew Wickline: But also all the other steps that six weeks before 12 weeks, that other 3000 plus hours that we could be optimizing, that's low hanging fruit, man.
• 13:47
  Andrew Wickline: That that's really the, that's when the patient's awake, by the way, when you know those other 3000 hours.
• 13:51
  Andrew Wickline: So you better be paying attention to that.
• 13:54
  Joseph M Schwab: Uh, my goodness.
• 13:55
  Joseph M Schwab: So that, that sounds like it was a really, um, a challenging experience at that, at, at the, the meeting.
• 14:01
  Joseph M Schwab: Were, were there other experiences that come to your mind that really challenged the way you, uh, were thinking or the way that you, you know, that transformed your approach to your patients?
• 14:13
  Andrew Wickline: You know, um, there's a lot of surgeons that have, you know, been, been helpful.
• 14:20
  Andrew Wickline: Uh, you know, at that meeting, the only person who stood up for me at that meeting was Adolf Lombardi.
• 14:24
  Andrew Wickline: I mean, that, that, that man's a real gentleman.
• 14:27
  Andrew Wickline: Uh, you know, he said, you know, Andy's been to my place twice and, uh, I think, I think he, he might be onto something.
• 14:33
  Andrew Wickline: And then over the years, you know, Frederick Load, uh, from Paris, I mean, just an amazing anterior hip surgeon.
• 14:39
  Andrew Wickline: Uh, and he's been doing a lot of, uh, videos recently on LinkedIn, you know, showing and highlighting.
• 14:43
  Andrew Wickline: Some of the things he's learned.
• 14:45
  Andrew Wickline: Um, uh, of course Joel Mata.
• 14:47
  Andrew Wickline: Um, he and I have shared love of airplanes, so, uh, I, I get to speak to Joel every so often.
• 14:53
  Andrew Wickline: Nick Mast, uh, um, Charlie to cook.
• 14:57
  Andrew Wickline: There's a whole bunch of surgeons that have, have showed me their little tricks and pearls and, uh.
• 15:02
  Andrew Wickline: I've been very fortunate and I, I, I would encourage all surgeons to spend time.
• 15:06
  Andrew Wickline: I just had a surgeon, uh, Jim Mitchell out from, uh, Oklahoma the last two days.
• 15:11
  Andrew Wickline: It's super helpful to have someone come to your place and, you know, help poke holes in your thinking to say, Hey, why are you doing it that way?
• 15:18
  Andrew Wickline: Is, is there, would this work, uh, a little bit better?
• 15:22
  Andrew Wickline: It's very, very, um, the collaborative nature of this is, has been really exciting.
• 15:28
  Joseph M Schwab: So you kind of touched on a, a number of folks who are in our sphere, in the anterior approach sphere with Dr.
• 15:33
  Joseph M Schwab: Matta and Dr.
• 15:34
  Joseph M Schwab: De Cook and, and Nick Mast and things like that.
• 15:37
  Joseph M Schwab: When did you start doing anterior approach?
• 15:39
  Joseph M Schwab: And I know one of.
• 15:41
  Joseph M Schwab: Your concerns is about pain management and opioid use.
• 15:44
  Joseph M Schwab: Did you see any differences in opioid needs between patients that you were doing anterior approach on and patients having other approaches?
• 15:52
  Andrew Wickline: Yeah.
• 15:53
  Andrew Wickline: So, um, you know, I, I, I have a, a, a.
• 15:57
  Andrew Wickline: My residency was almost entirely, um, uh, posterior.
• 16:03
  Andrew Wickline: I did a little direct lateral, um, at the time, and, uh, um, I.
• 16:09
  Andrew Wickline: We had a surgeon, uh, that was there, he was working on the two incision hip stuff.
• 16:13
  Andrew Wickline: So then I went and did my fellowship and, uh, that was all direct lateral with Leicester Borden and, uh, Cleveland Clinic.
• 16:20
  Andrew Wickline: And so I've got five years of practice, uh, uh, using direct lateral with good results.
• 16:25
  Andrew Wickline: But, you know, the, the limping, the, you know, the, the early recovery was a challenge, you know, no, it didn't have that dislocation risk with the posterior.
• 16:34
  Andrew Wickline: And so then we did some two incision stuff, uh, and then, um.
• 16:38
  Andrew Wickline: You know, the literature was coming out kind of against it in some ways, in some centers, so it was challenging to continue.
• 16:43
  Andrew Wickline: So that's when I fell into, uh, direct interior.
• 16:46
  Andrew Wickline: We did a bunch of courses.
• 16:48
  Andrew Wickline: I started in 2007.
• 16:50
  Andrew Wickline: I started without a table.
• 16:51
  Andrew Wickline: Like I, I, uh, moved over to using a table.
• 16:54
  Andrew Wickline: I found that much more reproducible, uh, and.
• 16:58
  Andrew Wickline: When, when we really started doing it, uh, for real, I didn't, you know, none of my office staff knew the difference.
• 17:05
  Andrew Wickline: My x-ray tech came to me and said, uh, Andrew, um.
• 17:08
  Andrew Wickline: You know, this is the time we had non-digital x-ray.
• 17:10
  Andrew Wickline: Right.
• 17:10
  Andrew Wickline: Andrew, what are you doing different?
• 17:12
  Andrew Wickline: Um, the patients can get on and off this supine, you know, x-ray table so much easier.
• 17:16
  Andrew Wickline: So is is there something different you're doing?
• 17:19
  Andrew Wickline: And then, uh, that's when I knew that I really had a game changer.
• 17:22
  Andrew Wickline: Um, and so yeah, it was, that was kind of the telling point for me in my office that this was definitely something different.
• 17:30
  Joseph M Schwab: Um, as far as pain control is concerned, did you notice any differences in patients or was it mostly functional recovery?
• 17:38
  Andrew Wickline: Uh, no, it was definitely both.
• 17:40
  Andrew Wickline: Uh, it's just the, the need for, for opioids, uh, was definitely lower.
• 17:46
  Andrew Wickline: Um, and, you know, we, we.
• 17:48
  Andrew Wickline: Ultimately, I had a physical therapist.
• 17:50
  Andrew Wickline: She, she thought she was gonna prove me wrong.
• 17:53
  Andrew Wickline: You know, the patients don't need therapy.
• 17:54
  Andrew Wickline: And so she wrote a paper with me and we actually saw about 90% of patients use 10 pills or less.
• 17:59
  Andrew Wickline: Uh, mostly tramadol.
• 18:01
  Andrew Wickline: And now with a few more tweaks with my protocol, I we're, we're gonna have to do another study.
• 18:06
  Andrew Wickline: 'cause I think we're at 80 to 90% using zero opioids now.
• 18:10
  Joseph M Schwab: Wow.
• 18:10
  Joseph M Schwab: Wow.
• 18:11
  Joseph M Schwab: Um, le let's talk a little bit about, you have, uh, something called the 1 million Patient Mission, um, which is, I would say inspiring and pretty bold.
• 18:23
  Joseph M Schwab: Um, the goal seems to be to help 1 million patients have zero opioid addiction risk after total hip and total knee replacements.
• 18:32
  Joseph M Schwab: What I'm curious is, from your perspective.
• 18:34
  Joseph M Schwab: How'd you come up with this mission, and specifically, how'd you come up with the number?
• 18:38
  Joseph M Schwab: A million is bold.
• 18:41
  Andrew Wickline: So.
• 18:42
  Andrew Wickline: The Baron Brothers again, I'm so lucky that many surgeons are willing to put up with me in their, or.
• 18:48
  Andrew Wickline: The Baron Brothers invited me out to their, their meeting, uh, a couple years ago, and that's, uh, happens, uh, that they brought in, uh, or, uh, Mor Malu.
• 18:58
  Andrew Wickline: I know, or I'm sorry if I'm saying your name wrong, he's the PhD, uh, that's works at Harris Hip Labs.
• 19:04
  Andrew Wickline: He's responsible for, um, cross-link polyethylene and, uh, when, when they started looking at numbers.
• 19:11
  Andrew Wickline: That guy has helped over 20 million people have a longer hip and knee replacements.
• 19:18
  Andrew Wickline: And I, I, for, for the last couple years, I'm like, man, I, I wish I had that kind of influence.
• 19:23
  Andrew Wickline: I have a very small sphere of influence, right?
• 19:24
  Andrew Wickline: My little town, you know, maybe a few people that you see our podcast and so forth, and use our books, but, you know, it's, it's not 20 million.
• 19:33
  Andrew Wickline: So I've been looking at my, I got 10 years left, uh, before I retire.
• 19:37
  Andrew Wickline: I think, uh, depending on how this stock market goes.
• 19:43
  Andrew Wickline: my kids decide to continue doing.
• 19:44
  Andrew Wickline: But, um, so I said, okay, there's about 1.6, uh, 1.7 million total joints a year.
• 19:51
  Andrew Wickline: If I could affect a hundred thousand a year, that'd be like 7% of the market.
• 19:56
  Andrew Wickline: Um, I.
• 19:57
  Andrew Wickline: You know, in 10 years when I retire, I, I could help a million people.
• 20:01
  Andrew Wickline: So I said, you know, that, I think I like this.
• 20:02
  Andrew Wickline: This let's march to a million.
• 20:04
  Andrew Wickline: Uh, and that's March the number two a million.com.
• 20:08
  Andrew Wickline: We have a website where, where patients can go on and, and surgeons can get my free DPDF.
• 20:13
  Andrew Wickline: And if your patient doesn't 10 pills or less, I want them to go to that.
• 20:16
  Andrew Wickline: Website, log in with their first name tag their surgeon claim their, their own personal number on the internet wall of fame, that they did it in 10 pills or less.
• 20:26
  Andrew Wickline: And we have a leaderboard where, where we're gonna find out which surgeons and which, uh, you know, cities and states are winning, uh, in this, this problem.
• 20:35
  Andrew Wickline: I mean.
• 20:36
  Andrew Wickline: In 2018, I published and presented 10 pills or less for total knee, like unheard of.
• 20:42
  Andrew Wickline: In 2020, we actually published those papers and then Covid hit and the whole national conversation left this opioid epidemic problem and we've gotta fix this.
• 20:51
  Andrew Wickline: I, one in four of my patients talked to me about personal family members.
• 20:56
  Andrew Wickline: Or, or a friends that, that they've lost because of opioids.
• 21:00
  Andrew Wickline: And I, I'm mad, you know, I thi this is fixable and so I've got a bunch of surgeons already signed onto this.
• 21:06
  Andrew Wickline: We're going to, we're gonna change, uh, the national conversation.
• 21:09
  Andrew Wickline: We're gonna get it back to where it belongs, and we're going to encourage all of other surgeons who aren't doing these things to, to improve pain perioperatively to get on board.
• 21:18
  Andrew Wickline: Yeah.
• 21:19
  Andrew Wickline: I think this should, this operation should be 10 pills or less.
• 21:22
  Joseph M Schwab: So we'll put a link to the March to a million in our description, certainly with the podcast.
• 21:27
  Joseph M Schwab: But I wanna know, uh, maybe you can give us a sneak peek.
• 21:29
  Joseph M Schwab: What progress have you made so far?
• 21:33
  Andrew Wickline: So again, I've, I've got 30 plus surgeons who, you know, they, they bought in, it's easy to buy in, right?
• 21:39
  Andrew Wickline: It's, it's essentially, you know, advertising their practice that, that they care enough, uh, to, to uh, uh, provide education, provide, uh, um.
• 21:50
  Andrew Wickline: techniques and.
• 21:52
  Andrew Wickline: Uh, allow patients to recover, uh, with a, with way less if zero, uh, risk of opioid addiction.
• 21:59
  Andrew Wickline: And so, you know, like that's, that's super hard to, to get surgeons together, right?
• 22:04
  Andrew Wickline: We, we all feel we're number one, we're all great white sharks in our little area of the ocean.
• 22:09
  Andrew Wickline: And so we have to find ways that we can collaborate.
• 22:12
  Andrew Wickline: And I think this is a great way, it's, it's a competition.
• 22:15
  Andrew Wickline: Uh, we're also doing a video documentary of this, uh.
• 22:19
  Andrew Wickline: So, yes, the, the I I I, I'm flying my little plane.
• 22:23
  Andrew Wickline: I pull it outta the hangar and I, uh, uh, I just picked up, uh, John Balk out of Cleveland to come out and visit with us.
• 22:28
  Andrew Wickline: Uh, I flew down to see John Mercury.
• 22:30
  Andrew Wickline: Uh, um, I'm flying down this, uh, coming week to see, uh, Del Shoote, uh, to, to give a lecture down there.
• 22:37
  Andrew Wickline: So, uh, pulling out my little march to a million plane, uh, with the big jets behind.
• 22:42
  Andrew Wickline: It's the story of my life, David versus Goliath.
• 22:44
  Andrew Wickline: I am gonna fix this problem.
• 22:46
  Andrew Wickline: Uh, I do not want these things on the.
• 22:48
  Joseph M Schwab: So, I mean, this is a huge lift that you're taking, and obviously it sounds like for a good cause the many of the surgeons who are signing up, they're making a pledge to do things differently.
• 22:59
  Joseph M Schwab: But if there was one small change a surgeon or a care team could make today that would create, um, from your perspective, a huge impact in recovery or outcomes for their patients, what would that be?
• 23:15
  Andrew Wickline: Uh, so I agree, starting small is the key.
• 23:17
  Andrew Wickline: Uh, um, any of the surgeons listening that can reach out to me, I've got, you know, 40 plus ways to help reduce swelling.
• 23:24
  Andrew Wickline: You know, again, part of it's in the book, but, you know, you don't have to use my book to do this.
• 23:28
  Andrew Wickline: Um, the first thing I would say is, uh, let's look at the step count man Dome Karina Outta Florida.
• 23:34
  Andrew Wickline: Neither of us knew we were doing this research, but both of us came up with the same step count post-op, uh, to help patients recover, right?
• 23:41
  Andrew Wickline: Again, we talked about this earlier.
• 23:42
  Andrew Wickline: If you sprain your ankle badly, you don't try to do 10,000 steps the next day, but yet for knees and hips, we tell patients to go, go, go.
• 23:50
  Andrew Wickline: But, but that's not what we tell patients for a rotator cuff or having a hernia repair or any other surgery.
• 23:56
  Andrew Wickline: So we have to understand that the, the, the wound is more than just the bone that we pounded parts into.
• 24:03
  Andrew Wickline: Uh, we've got to help that wound, uh, uh, heal better.
• 24:07
  Andrew Wickline: And that's by controlling that swelling.
• 24:09
  Andrew Wickline: There's.
• 24:09
  Andrew Wickline: There's a lot of great stuff we're gonna be working on the near term.
• 24:12
  Andrew Wickline: Um, and, uh, but, but I think number one key is start with the step count.
• 24:16
  Andrew Wickline: Number two, recognize that swelling is a real thing.
• 24:19
  Andrew Wickline: I mean, 34% more water on the leg on day seven, uh, not day one or two, but day seven a week later, it's only 2% less, so 32% more one on a leg.
• 24:29
  Andrew Wickline: We have to manage that, and until we recognize that those are real parts, then you're not gonna see the success.
• 24:36
  Joseph M Schwab: Do you have a message for surgeons who currently feel stuck in sort of the traditional models of care?
• 24:44
  Andrew Wickline: So.
• 24:46
  Andrew Wickline: Yeah, I guess, uh, I'm, I'm happy to either come visit you or you can come visit me.
• 24:50
  Andrew Wickline: Um, we, you know, the very first person that came to visit was a surgeon out of, uh, uh, LA and um, uh, this was back in 2018 after he heard the talk and I we're driving to my clinic and he says, I said, why, why did you come all the way to, you know, Utica, New York?
• 25:06
  Andrew Wickline: And he goes, because I call BS on your results.
• 25:08
  Andrew Wickline: There's no way you're doing this in 10 pills or less.
• 25:10
  Andrew Wickline: And, um, and, uh, after four hours in clinic, he goes, okay, uh, I believe you now, and I'm gonna make these changes.
• 25:18
  Andrew Wickline: And it, there's just, it's just some simple changes and you don't have to do it all at once.
• 25:23
  Andrew Wickline: You know, start with some simple things, you know, it's a six month process.
• 25:26
  Andrew Wickline: I've, I've got a kind of roadmap for patients, uh, and for surgeons as well, um, to, to help succeed.
• 25:33
  Andrew Wickline: Again, if you try to do it all at once, it is overwhelming.
• 25:35
  Andrew Wickline: Agreed.
• 25:36
  Joseph M Schwab: When you have the opportunity to look back on your legacy, um, through your books, through your patient care, through the, this, the the million patient mission and your global collaborations, um, what do you want it to look like?
• 25:53
  Andrew Wickline: I guess I just wanna know that, that I did more, I mean, it's important to help our people in our local town, but at some point I.
• 26:01
  Andrew Wickline: Those of us who've been doing this a long time, it's time to give back to the younger surgeon that is still struggling on trying to understand what, you know, again, how does a 30 5-year-old surgeon understand what it's like to have a knee replacement?
• 26:14
  Andrew Wickline: Really, you know, uh, unless they have one themselves or they go and, and live with that person, uh, for the next six weeks.
• 26:21
  Andrew Wickline: So, um, I think it's.
• 26:24
  Andrew Wickline: It's incumbent upon, uh, older surgeons to just, you know, share the wisdom that we have and, you know, the dos and the don'ts and, uh, but again, to keep trying to push forward.
• 26:34
  Andrew Wickline: Um, I'm excited for what the future holds.
• 26:36
  Andrew Wickline: I, I don't know.
• 26:37
  Andrew Wickline: I, I, my, my belief is that in the next 15 to 20 years, we may not be putting metal in, plastic in, I think we'll be replicating cartilage 3D printing with nanobots.
• 26:48
  Andrew Wickline: Um, but the key will still be understanding the.
• 26:51
  Andrew Wickline: The, the cytokine milieu in that knee and understanding the basement membrane adhesion, uh, and uh, uh, trying to mitigate those shear forces to allow that healing to occur.
• 27:02
  Andrew Wickline: So I'm excited.
• 27:03
  Andrew Wickline: I hope I get to see that.
• 27:04
  Andrew Wickline: Um, but I think it's coming.
• 27:06
  Joseph M Schwab: What, so you, you talked briefly about what you think, uh, the surgery will look like in, in 20, 30, 50 years.
• 27:15
  Joseph M Schwab: What do you think the recovery's gonna look like in 50 years?
• 27:19
  Andrew Wickline: That's hard.
• 27:20
  Andrew Wickline: It's hard for me to know.
• 27:21
  Andrew Wickline: I, I.
• 27:23
  Andrew Wickline: Um, you know, we have our cells are, you know, we're over 50.
• 27:26
  Andrew Wickline: Our cells are, they call'em senescent, which is, is a terrible word, but That's true, you know, and, um, and so these cells act as, uh, pericrine cells.
• 27:35
  Andrew Wickline: So they, they control the surrounding milieu in near, in the regions of trauma.
• 27:39
  Andrew Wickline: So the next five years, I'd like to see, um.
• 27:42
  Andrew Wickline: I'm trying to work with some of our, uh, um, basic science, uh, members, uh, inflammation, uh, specialists, as well as gate specialists.
• 27:50
  Andrew Wickline: I'd love to sit down and work with them on another kind of landmark paper looking at how do these senescent cells, instead of going down that fibrotic pathway, how do we get them to go back to that?
• 28:01
  Andrew Wickline: That reparative pathway.
• 28:03
  Andrew Wickline: And I think by understanding that that's gonna help us, uh, as uh, the technology allows us to do things with cartilage surfaces, I think we, we need to have that together.
• 28:12
  Andrew Wickline: We can't, we can't have one without the other.
• 28:15
  Andrew Wickline: So, um, I'm excited that the short term, I think we can help recovery, uh, by looking at the, how the soft tissue reacts to the trauma.
• 28:23
  Andrew Wickline: And in the long term, uh, I don't know.
• 28:25
  Andrew Wickline: I'm, I'm, I still hit things with a hammer, so it may be.
• 28:31
  Joseph M Schwab: Uh, well, I can't think of a better place to end than that, but Dr.
• 28:35
  Joseph M Schwab: Wickline, I I really appreciate the time that you've taken with us today, and I look forward to hearing your full talk at the AHF uh, 2025 annual meeting.
• 28:44
  Andrew Wickline: Thank you so much for having me and uh, really, uh, I really appreciate the opportunity.
• 28:49
  Joseph M Schwab: Absolutely.
• 28:51
  Joseph M Schwab: you for joining me for this episode of the AHF podcast.
• 28:54
  Joseph M Schwab: We think of the AHF as a family, so if you can remember to take a moment to like and subscribe, you'd be helping us find more people just like you to share our thoughts with.
• 29:05
  Joseph M Schwab: And as an AHF family member, you can always drop an idea for a topic or any feedback you like.
• 29:11
  Joseph M Schwab: In the comments below, you can find us on Apple Podcasts, Spotify, or in any of your favorite podcast apps, as well as in video form on YouTube slash at anterior hip Foundation, all one word.
• 29:27
  Joseph M Schwab: New episodes of the ahf Podcast come out on Fridays.
• 29:31
  Joseph M Schwab: I'm your host, Joe Schwab, asking you to keep those hips happy, healthy, and swelling free.